{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:45:43Z","timestamp":1787755543243,"version":"build-2784847793"},"reference-count":76,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,5,7]]},"abstract":"<jats:p>\n                    <jats:list list-type=\"plain\">\n                      <jats:list-item>\n                        <jats:p>\u27a2 Risk stratification in orthopaedic surgery is complex and depends on the outcome of interest and multiple interdependent factors. Effective risk stratification has uses for limiting and predicting adverse events in patients undergoing discretionary surgery, avoiding the penalization of surgeons for operating on candidates whose health is situated in more difficult circumstances, and ensuring that inordinate attention is not placed on discrete musculoskeletal pathophysiology when there are other pressing health priorities.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u27a2 For individual patient decision-making, no comprehensive risk-stratification tool currently exists, in part due to the heterogeneity of orthopaedic procedures performed and the diverse patient population treated. The Elixhauser Comorbidity Measure and the Risk Stratification Index 3.0 appear to be most promising.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u27a2 At a population level, risk stratification may be useful in alternative payment models to ensure that hospitals that treat a disproportionate number of high-risk patients are not penalized and that cherry-picking (preferentially selecting only healthier patients with a lower risk of complications) does not occur. Any attempt to risk-stratify may have unintended consequences.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u27a2 Orthopaedic surgeons must be aware of the tools available, their strengths, and their limitations in order to be included in decision-making as payment models and public health policies are implemented.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:p>","DOI":"10.2106\/jbjs.24.00034","type":"journal-article","created":{"date-parts":[[2025,3,30]],"date-time":"2025-03-30T16:35:31Z","timestamp":1743352531000},"page":"1005-1017","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Risk Stratification in Orthopaedic Surgery"],"prefix":"10.2106","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6849-2871","authenticated-orcid":false,"given":"Alex B.","family":"Boyle","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"},{"name":"Harvard T.H. Chan School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5593-7939","authenticated-orcid":false,"given":"Andreea R.","family":"Lucaciu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1784-3288","authenticated-orcid":false,"given":"David N.","family":"Bernstein","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"},{"name":"Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7003-6138","authenticated-orcid":false,"given":"Mitchel B.","family":"Harris","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4409-6062","authenticated-orcid":false,"given":"Anoop","family":"Prasad","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6168-0175","authenticated-orcid":false,"given":"Daniel G.","family":"Tobert","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,3,28]]},"reference":[{"issue":"Suppl 5","key":"bib1-20250509","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/BOT.0000000000002447","article-title":"Recovery after musculoskeletal injury: mental and social health","volume":"36","author":"Ring","year":"2022","journal-title":"J Orthop Trauma."},{"issue":"13","key":"bib2-20250509","doi-asserted-by":"crossref","first-page":"e89","DOI":"10.2106\/JBJS.17.01159","article-title":"The future of orthopaedic care: promoting psychosocial resiliency in orthopaedic surgical practices","volume":"100","author":"Zale","year":"2018","journal-title":"J Bone Joint Surg Am."},{"issue":"8","key":"bib3-20250509","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1001\/jama.2014.18171","article-title":"Optimizing high-risk care management","volume":"313","author":"Powers","year":"2015","journal-title":"JAMA."},{"issue":"4","key":"bib4-20250509","doi-asserted-by":"crossref","first-page":"e128","DOI":"10.2196\/resprot.5039","article-title":"Using computational approaches to improve risk-stratified patient management: rationale and methods","volume":"4","author":"Luo","year":"2015","journal-title":"JMIR Res Protoc."},{"issue":"11","key":"bib6-20250509","doi-asserted-by":"crossref","first-page":"2430","DOI":"10.1097\/CORR.0000000000001792","article-title":"Is there an association between bundled payments and \u201ccherry picking\u201d and \u201clemon dropping\u201d in orthopaedic surgery? 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